Royal College of Obstetricians and Gynaecologists. Information for you after a laparoscopy

Transcription

1 Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy

2 Who is this information for? This information is for you if you are about to have, or you are recovering from, a laparoscopy (keyhole surgery). You might also find it useful to share this information with your family and friends. You may be having, or have had, a laparoscopy: to help your gynaecologist make a diagnosis by looking inside your pelvis this is known as a diagnostic laparoscopy as a treatment this is known as an operative laparoscopy and includes procedures such as: sterilisation or a small amount of treatment of endometriosis (simple procedures) removal of an ovarian cyst, treatment of an ectopic pregnancy, removal of one or both ovaries or division of scar tissue (intermediate procedures) treatment of severe endometriosis or hysterectomy (major procedures). If you are having a hysterectomy, you may find helpful information in Recovering Well: Information for you after a laparoscopic hysterectomy. This information is for you if you are having, or have had, a diagnostic laparoscopy and/or an operative laparoscopy where simple or intermediate procedures are performed. Your choices will depend on your personal circumstances and will be discussed with you by your gynaecologist before your operation. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 2

3 About this information You should read this information along with any other information you have been given about your choices and the operation itself. This information gives general advice based on women s experiences and expert opinion. Every woman has different needs and recovers in different ways. Your own recovery will depend upon: how fit and well you are before your operation the reason you are having a laparoscopy the exact type of laparoscopy that you have how smoothly everything goes and whether there are any complications. What can I expect after a laparoscopy? Usual length of stay in hospital If you are having a diagnostic laparoscopy, you should be able to go home on the same day. This operation is usually done as a day case. When you wake from the anaesthetic, your nurse will want to make sure that you are not in pain, that you have had something to eat and drink and that you have passed urine before you are discharged. This usually takes between 3 to 4 hours. When you go home, make sure you are not alone and someone can stay with you overnight. If you have had a simple procedure as part of an operative laparoscopy, you may be able to go home on the same day or you may be asked to stay in hospital overnight. After-effects of general anaesthesia Most modern anaesthetics are short-lasting. You should not have, or suffer from, any after-effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired. If you drink any alcohol after you leave hospital during this time, it will affect Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 3

4 you more than normal. You should have an adult with you during this time and should not drive or make any important decisions. Scars Stitches and dressings You will have between one and four small scars on different parts of your abdomen one scar will usually be in your tummy button. Each scar will be between 0.5 cm and 1 cm long. Your cuts will be closed by stitches, staples, clips or glue. Glue and some stitches dissolve by themselves. Other stitches, clips or staples need to be removed. This is usually done by the practice nurse at your GP surgery about 5 to 7 days after your operation. You will be given information about this. Initially, your cuts will be covered with a dressing. You should be able to take this off about 24 hours after your operation and have a wash or shower (see section on Washing and showering). Vaginal bleeding Pain and discomfort You may get a small amount of vaginal bleeding for 24 to 48 hours. You can expect some pain and discomfort in your lower abdomen for the first few days after your operation. You may also have some pain in your shoulder. This is a common side-effect of the operation. When leaving hospital, you will usually be provided with painkillers for the pain you are experiencing. If you are prescribed painkillers which contain codeine or dihydrocodeine, these can make you sleepy, slightly sick and constipated. If you do need to take these medications, try to eat extra fruit and fibre to reduce the chances of becoming constipated. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 4

5 Washing and showering Formation of blood clots how to reduce the risk You should be able to have a shower or bath and remove any dressings 24 hours after your operation. When you first take a shower or bath, it is a good idea for someone to be at home with you to help you if you feel faint or dizzy. Don t worry about getting your scars wet just ensure that you pat them dry with clean disposable tissues or let them dry in the air. Keeping scars clean and dry helps healing. There is a small risk of blood clots forming in the veins in your legs and pelvis (deep vein thrombosis) after any operation. These clots can travel to the lungs (pulmonary embolism) which could be serious. You can reduce the risk of clots by: being as mobile as you can as early as you can after your operation doing exercises when you are resting, for example: pump each foot up and down briskly for 30 seconds by moving your ankle move each foot in a circular motion for 30 seconds bend and straighten your legs one leg at a time, three times for each leg. You may also be given other measures to reduce the risk of a clot developing, particularly if you are overweight or have other health issues. These may include: a daily injection of a blood thinning agent; your doctor will advise you on the length of time you should take this for graduated compression stockings; the stockings should be worn day and night until your movement has improved and your mobility is no longer significantly reduced special boots that inflate and deflate. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 5

6 Starting HRT (hormone replacement therapy) Talking with your gynaecologist after your operation Tiredness What can help me recover? A daily routine Eat a healthy balanced diet If your ovaries have been removed during your operation you may be offered HRT. This will be discussed with you by your gynaecologist and together you can decide the best way forward. Your gynaecologist or another member of the surgical team may come and talk with you after your operation. Because you may still be coming round from the effects of the anaesthetic, it may be helpful for someone to be with you during this discussion. That way, you can both ask questions and talk later on about what was said. You may feel much more tired than usual after your operation as your body is using a lot of energy to heal itself. You may need to take a nap for the first few days. Very often feeling tired is the last symptom to improve. It takes time for your body to heal and for you to get fit and well again after a laparoscopy. There are a number of positive steps you can take at this time. The following will help you recover: Establish a daily routine and keep it up. For example, try to get up at your usual time, have a wash and get dressed, move about and so on. Sleeping in and staying in bed can make you feel depressed. Try to complete your routine and rest later if you need to. Ensure your body has all the nutrients it needs by eating a healthy balanced diet. A healthy diet is a highfibre diet (fruit, vegetables, wholegrain bread and cereal) with up to 2 litres a day of fluid intake, mainly water. Remember to eat at least five portions of fruit and vegetables each day. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 6

7 Stop smoking A positive outlook Stopping smoking will benefit your health in all sorts of ways such as lessening the risk of a wound infection or chest problems after your anaesthetic. By not smoking even if it is just while you are recovering you will bring immediate benefits to your health. If you are unable to stop smoking before your operation, you may need to bring nicotine replacements for use during your hospital stay. You will not be able to smoke in hospital. If you would like information about a smoking cessation clinic in your area speak with the nurse in your GP surgery. Your attitude towards how you are recovering is an important factor in determining how your body heals and how you feel in yourself. You may want to use your recovery time as a chance to make some longerterm positive lifestyle choices such as: starting to exercise regularly if you are not doing so already and gradually building up the levels of exercise that you take eating a healthy diet. If you are overweight it is best to eat healthily without trying to lose weight for the first couple of weeks after the operation. After that you may want to lose weight by combining a healthy diet with exercise. What can slow down my recovery? It can take longer to recover from a laparoscopy if: you had health problems before your operation; for example, women with diabetes may heal more slowly and may be more prone to infection you smoke; some women who smoke are at increased risk of getting a chest or wound infection during their recovery: smoking can delay the healing process Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 7

8 you were overweight at the time of your operation; if you are overweight it can take longer to recover from the effects of anaesthesia and there can be a higher risk of complications such as infection and thrombosis there were any complications during your operation. Recovering after an operation is a very personal experience. If you are following all the advice you have been given but do not think you are at the stage you ought to be, talk with your GP. When should I seek medical advice after a laparoscopy? While most women recover well after a laparosopy, complications can occur as with any operation. You should seek medical advice from your GP, the hospital where you had your operation, NHS Direct, NHS 24 or if you experience: burning and stinging when you pass urine or pass urine frequently: this may be due to a urine infection. Treatment is with a course of antibiotics. red and painful skin around your scars: this may be caused by a wound infection. Treatment is with a course of antibiotics. increasing abdominal pain: if you also have a temperature (fever), have lost your appetite and are vomiting, this may be caused by damage to your bowel or bladder, in which case you will need to be admitted to hospital. a painful, red, swollen, hot leg or difficulty bearing weight on your legs: this may be caused by a deep vein thrombosis (DVT). If you have shortness of breath, chest pain or cough up blood, it could be a sign that a blood clot has travelled to the lungs (pulmonary embolus). If you have these symptoms, you should seek medical help immediately. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 8

9 there is no improvement in your symptoms: you should expect a gradual improvement of your symptoms over time. If this is not the case, you should seek medical advice. Getting back to normal Around the house While it is important to take enough rest, you should start some of your normal daily activities as soon as you feel able. You will find you are able to do more as the days pass. If you feel pain you should try doing a little less for another few days. Remember to lift correctly by having your feet slightly apart, bending your knees, keeping your back straight and bracing (tightening or strengthening) your pelvic floor and stomach muscles as you lift. Hold the object close to you and lift by straightening your knees. Exercise The day after your operation you should be able to go for a short 10 to15 minute walk in the morning and the afternoon, having a rest afterwards if you need to. You should be able to increase your activity levels quite rapidly over the first week. There is no evidence that normal physical activity levels are in any way harmful and a regular and gradual build-up of activity will assist your recovery. Most women should be able to walk slowly and steadily for 30 to 60 minutes by the middle of the first week and will be back to their previous activity levels by the second week. Swimming is an ideal exercise and if you have had no additional procedure you can start as soon as you feel comfortable. If you have had other procedures with the laparoscopy you may need to avoid contact sports and power sports for a few more weeks, although this will depend on your level of fitness before your surgery. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 9

10 Driving You should not drive for 24 hours after a general anaesthetic. Each insurance company will have its own conditions for when you are insured to start driving again. Check your policy. Travel plans Before you drive you should be: free from the sedative effects of any painkillers able to sit in the car comfortably and work the controls able to wear the seatbelt comfortably able to make an emergency stop able to comfortably look over your shoulder to manoeuvre. It is a good idea to practise without the keys in the ignition. See if you can do the movements you would need to for an emergency stop and a three-point turn without causing yourself any discomfort or pain. When you are ready to start driving again, build up gradually, starting with a short journey. If you are considering travelling during your recovery, it is helpful to think about: The length of your journey: journeys over 4 hours where you are not able to move around (in a car, coach, train or plane) can increase your risk of deep vein thrombosis (DVT). This is especially so if you are travelling soon after your operation. How comfortable you will be during your journey, particularly if you are wearing a seatbelt. Overseas travel: Would you have access to appropriate medical advice at your destination if you were to have a problem after your operation? Does your travel insurance policy cover any necessary medical treatment in the event of a problem after your operation? Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 10

11 Are your plans in line with the levels of activity recommended in this information? If you have concerns about your travel plans, it is important to discuss these with your GP or the hospital where you have your operation before travelling. Having sex Returning to work For many people, being able to have sex again is an important milestone in their recovery. It is safe to have sex when you feel ready. If your vagina feels dry, especially if you have had both ovaries removed, try using a lubricant. You can buy this from your local pharmacy. Most women feel able to return to work 1 to 3 weeks after a laparoscopy. If you have had a diagnostic laparoscopy or a simple procedure such as a sterilisation you can expect to feel able to go back to work within 1 week. Although you will not be harmed by doing light work just after surgery, it would be unwise to try to do much within the first 48 hours. If you have a procedure as part of an operative laparoscopy, such as removal of an ovarian cyst, you can expect to return 2 to 3 weeks after your operation. If you feel well, you will not be harmed by doing light work on reduced hours after a week or so. When you go back to work will depend on the type of job you do. If you do heavy manual work or are on your feet all day, you may need longer than someone who can sit down at work. You do not need to avoid lifting or standing after this type of operation but you may feel more tired if you have a physically demanding job. If you are off work for less than 1 week, you should be able to complete a self-certificate for the time you have been off work. If it is longer than 1 week, you will need to obtain a certificate from the hospital where you had your operation. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 11

12 You might also wish to see your GP or your occupational health department before you go back and do certain jobs discuss this with them before your operation. You should not feel pressurised by family, friends or your employer to return to work before you feel ready. You do not need your GP s permission to go back to work. The decision is yours. Royal College of Obstetricians and Gynaecologists Information for you after a laparoscopy 12

13 The Royal College of Obstetricians and Gynaecologists 27 Sussex Place, London NW1 4RG More Patient Information is available on our website: